Thoracoscopic Aortopexy for the Treatment of Pediatric Tracheomalacia: A Right-Sided Approach

Abstract

Tracheomalacia (TM) refers to a softening of the cartilaginous tracheal rings. The weakened cartilage allows a narrowing in the anteroposterior tracheal diameter. Its incidence is estimated to be 1 in 1445 infants. Both congenital and acquired forms have been identified. Congenital TM is most commonly associated with tracheoesophageal fistula/ esophageal atresia in children. 1 The effected tracheal rings have been found to contain a shortened segment of cartilage with a compensatory lengthening of the membranous portion. 2 This is thought to be caused by abnormal embryonic separation of the trachea from the esophagus, leaving the trachea with too much tissue. 1 Primary TM has also been associated with immature cartilage in premature infants, primarycartilagedisorderssuchaspolychondritisandchondromalacia, and several syndromes including the mucopolysaccharidoses and Down syndrome. The acquired or secondary forms of TM are more common than the primary forms and result from prolonged endotracheal intubation or tracheostomy. Secondary TM can also be the result of external compression from surrounding cardiovascular anomalies, skeletal disorders such as scoliosis, and space-occupying tumors or cysts. 3 The weakened trachea is subsequently susceptible to collapse with increased intrathoracic pressure, as in expiration, coughing, and crying. It is also vulnerable to external pressures created by food boluses, dilations proximal to esophageal strictures following tracheoesophageal fistula/esophageal atresia repair, and regurgitation due to gastroesophageal reflux disease. Patients present with noisy breathing, barking or“TOF”(tracheo-oesphagealfistula)cough,recurrentrespiratoryinfections,feedingdifficulties,andapneicspells. 1 Mild